Thyroid papillary carcinoma (PTC) is a rapidly growing malignant tumor worldwide, but is generally associated with very good long-term outcome after radical management, including surgery. Therefore, factors usually regarded as subsidiary related to cancer treatment, such as minimally invasive and aesthetic results, may be thought important. Conventional open thyroidectomy (COT) is the most commonly used approach for thyroidectomy. COT allows good direct exposure for both thyroid lobes and central neck compartment. However, COT normally requires a long collar incision (usually 5–8 cm in length) on the anterior neck [1]. The patient demand of improved cosmesis has driven the development of various innovative surgical methods intended to conceal or minimize the surgical scar, such as remote access endoscopic thyroidectomy, minimally invasive video-assisted thyroidectomy (MIVAT) and mini-incision open thyroidectomy. Remote access endoscopic thyroid surgery brings about satisfying cosmetic outcomes without visible scars in the neck, but may be invasive due to extensive subcutaneous dissection to reach the thyroid [2]. Moreover, it is associated with less retrieved lymph nodes, and its role in the treatment of thyroid cancer has been highly disputed [3], [4]. Mini-incision open thyroidectomy is defined as thyroidectomy using incision smaller than that often needed in conventional thyroidectomy [5] and the incision length is usually defined to up to 3.5 cm [6]. The incision is placed higher in the neck compared to the classic Kocher incision, usually directly over the cricoid. This technique has been demonstrated to be minimally invasive, however, it has the disadvantages of narrow operative window and difficult dissection of the back of the thyroid bed where is the location of key anatomic structures including the recurrent laryngeal nerve and parathyroid glands due to a limited view [7]. The principal surgeon needs to wear a headlight and is usually the only one who has direct continuous view of the operative field and this is unfriendly in academic environment. MIVAT with gasless mechanical retraction pioneered by Miccoli has been verified to be associated with less postoperative pain and improved aesthetic results in selected cases [8]. Nevertheless, it has certain technical defects, such as narrow working space and difficulty in maintaining a stable screen image [9], [10]. The operating time is usually overtly prolonged than that of COT [11], [12].

In February 2021, we designed a hybrid technique for thyroidectomy, single-port endoscopy-assisted thyroidectomy via cervical gas-insufflation approach (SPEAT, also called the Huang procedure) [13], which is a combination of gas-insufflation single-port endoscopic surgery and mini-incision open surgery. This technique is reported to be able to provide good cosmetic results and minimize tissue trauma while maintaining stable and adequate exposure in the treatment of benign thyroid nodules [14]. However, its effectiveness in the treatment of PTC needs to be explored. The purpose of this study was to evaluate the preliminary results of safety and clinical efficacy of this technique in the treatment of PTC and compare the results with those achieved by COT.